Imaging Manifestations Research Articles

An ARFID case report assessment with 18F-FDG PET/MRI and treatment with olanzapine, escitalopram and fluoxetine in adult

BackgroundAvoidant/restrictive food intake disorder (ARFID), a DSM-5-introduced eating disorder, is increasingly prevalent and challenging to treat, primarily affecting children and adolescents, with limited adult case reports. This rarity in adults leads to misdiagnosis or underdiagnosis, and treatment experiences are scarce.Case presentationThis report details an adult ARFID case, where the patient’s fear of food intake followed gastric damage from corn ingestion, resulting in a restrictive diet of rice porridge due to gastric pain. The behavior is driven by fear of eating-related adverse effects.ResultBased on clinical symptoms assessment, semi-structured interviews, and comprehensive testing, including PET/MRI scans to exclude secondary conditions, a diagnosis of ARFID was confirmed. ARFID, a newly introduced diagnosis in the DSM-5, is uncommon in adults with sparse case data. Differentiating it from gastrointestinal diseases and other psychiatric conditions is crucial for precise diagnosis and focused treatment.ConclusionIn this paper, we report on the clinical diagnosis, imaging manifestations, treatment, and follow-up of an adult ARFID case, highlighting the utility of neuroimaging in diagnosis and differentiation. It also assesses the therapeutic efficacy of olanzapine, escitalopram oxalate, and fluoxetine hydrobromide, offering clinical guidance for diagnosing and managing ARFID.

Pulmonary Aspiration Syndromes: An Imaging-based Review.

The term "aspiration" describes lung injury that results from unintentional passage of contents other than air into the lungs and bronchial tree, commonly from the gastrointestinal and upper respiratory tracts. Only a small proportion of aspiration-related events are symptomatic, especially in predisposed individuals such as patients with diminished consciousness, impaired swallowing, oesophageal motility disorders, and reflux disease. Aspiration-related syndromes can be classified based on the onset of presentation, composition of the aspirated substance, and anatomic site of injury. When considering the injury site, the aspirated material can either obstruct the airways, thereby presenting with obstructive features (eg, atelectasis on radiographs); it can alternatively affect the lung parenchyma. Lung injury due to aspiration of noxious agents such as acid or lipids is termed chemical aspiration pneumonitis. The aspirated contents can alternatively lead to lung parenchymal infection when the contents are infected, which is termed aspiration pneumonia. We have reviewed the imaging manifestations of various entities related to aspiration and have classified the abnormalities based on the site of injury and the nature of the culprit agent. Differences between "aspiration pneumonitis" and "aspiration pneumonia" are also explored. This is followed by an illustration of a few specific situations related to aspiration in pediatric and adult patients.

Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive to Steroids Presenting With Predominantly Neuro-Ophthalmic Features.

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare and poorly understood inflammatory disorder of the central nervous system centered on the pons. It has a characteristic imaging appearance with enhancing and T2-hyperintense punctate and curvilinear lesions in the pons. The lesions lack restricted diffusion and have relatively little perilesional edema. Although patients typically present with gait ataxia and other sequelae of brainstem inflammation including diplopia, there is scant literature focusing on patients who present with primarily neuro-ophthalmic manifestations. Case series of 3 patients presenting with diplopia who had a final diagnosis of CLIPPERS. Case descriptions of a 71-year-old man, 61-year-old woman, and 38-year-old man are reported. Diplopia was the chief presenting complaint, owing to internuclear ophthalmoplegia, sixth nerve palsy, or skew deviation. All patients had nystagmus and gait ataxia. Brain MRI displayed punctate or curvilinear enhancement of pontine/middle cerebellar peduncle lesions without restricted diffusion. All patients achieved rapid improvement after corticosteroid treatment. In 3 patients with CLIPPERS, the main presenting complaint was diplopia. The distinctive imaging signs led to a strong presumption of CLIPPERS, permitting a truncated evaluation and early corticosteroid treatment, which provided rapid reversal of clinical and imaging manifestations.

Advanced Imaging Techniques for Assessing Fat, Iron, and Fibrosis in Chronic Liver Disease.

Imaging plays a critical role in the management of chronic liver disease (CLD) because it is a safe and painless method to assess liver health. The widely used imaging techniques include ultrasound, computed tomography and magnetic resonance imaging. These techniques allow the measurement of fat deposition, iron content, and fibrosis, replacing invasive liver biopsies in many cases. Early detection and treatment of fibrosis are crucial, as the disease can be reversed in its early stages. Imaging also aids in guiding treatment decisions and monitoring disease progression. In this review, we describe the most common imaging manifestations of liver disease and the current state-of-the-art imaging techniques for the evaluation of liver fat, iron, and fibrosis.

Imaging and management of calcium pyrophosphate deposition disease.

The radiological manifestations of calcium pyrophosphate deposition (CPPD) revolve around two main axes: the asymptomatic form and CPPD disease. The latter is a consequence of an immune response to calcium phosphate crystals. Chondrocalcinosis is broadly considered the radiographic manifestation of CPPD regardless of whether it is asymptomatic or associated with inflammatory arthritis. CPPD is associated with osteoarthritis although the direction of such association is still unclear. Apart from the detection of CPP crystals in synovial fluid, imaging (mainly conventional radiography and increasingly ultrasound) plays a central role in the diagnosis of CPPD disease. Recently, CT has been added as a diagnostic tool, especially in deep anatomic locations such as crowned dens. To date, no treatment is effective in dissolving CPP crystals. For now, the focus of current treatment strategies remains inflammation control. Our aim is to review the epidemiology, pathogenesis, and clinical and imaging manifestations of asymptomatic and symptomatic CPPD. We will also discuss recent consensus definitions and classifications of CPPD disease.

Thoracic and Cardiovascular Imaging Manifestations of Lupus.

Systemic lupus erythematosus (SLE), commonly referred to as lupus, is a widely prevalent chronic autoimmune disease that can affect any organ system in the body. Although the pathogenesis of this disease is rather complex and poorly understood, ultimately there is an overproduction of multiple self-reactive antinuclear antibodies. These autoantibodies are one of the laboratory hallmarks of the diagnosis and disease activity of SLE. Lupus has a myriad of symptoms and imaging manifestations. Serositis, one of the most common manifestations of the disease, usually occurs with pleural or pericardial effusion with or without associated serosal inflammatory changes. The pulmonary manifestations are heterogeneous, with mostly acute (eg, diffuse alveolar hemorrhage, acute lupus pneumonitis) and some chronic (eg, fibrosing interstitial lung disease, shrinking lung syndrome) lung findings. Cardiac and vascular manifestations include myocarditis; coronary artery disease, including accelerated atherosclerosis; myocardial infarction; and spontaneous dissections, along with vasculitis, aneurysms, Libman-Sacks endocarditis, and arterial and venous thromboembolism. Although patient history and risk factor assessment have a vital role in diagnosing lupus, familiarity with the imaging manifestations aids radiologists in optimizing patient care, assessing for complications, and uncovering undiagnosed cases of lupus. This fact emphasizes the importance of recognizing the complex multisystem involvement of lupus seen at imaging. In this article, the authors review the thoracic and cardiovascular imaging manifestations of lupus. © RSNA, 2024.

Imaging Manifestations Following Radiation Therapy for Lung Cancer

Imaging Manifestations Following Radiation Therapy for Lung Cancer

Crises and Reforms of the Body

The use of the body – whether it referred to representations of the leader through media or artistic image, sculpture, photography, or specific choreographed manifestations – is a recognizable tool for building and nurturing the personality cult of Josip Broz Tito and communicating with the People. The crisis of the socialist society and the ideological shift was therefore accompanied by sudden changes, neglect, even literal cutting and melting of the monumental heritage, removal, and destruction of Tito's representations, and the forced oblivion of collective performances that once celebrated Yugoslavia and its leader. In this paper, the Museum of Yugoslavia in Belgrade and its surroundings will serve as the point of departure for further reflection on the creation of a personality cult, as well as its subsequent deconstruction and recontextualization followed by the notion of the body's bond to this space. Starting from the appearance of the literal and the symbolical body of the leader, as well as the collective body in the context of the 25th of May performance and commemoration happening in the same area, we will follow how these bodies transform over time at the same place through the medium of contemporary art and curatorial practice.

Atypical imaging manifestations in non-alcoholic Wernicke's encephalopathy: a potentially reversible neurological condition not to be missed.

Atypical imaging manifestations in non-alcoholic Wernicke's encephalopathy: a potentially reversible neurological condition not to be missed.

Desmoplastic Small Round Cell Tumor: a study of CT, MRI, PET/CT multimodal imaging features and their correlations with pathology

PurposeExploring the computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (FDG-PET)/CT Multimodal Imaging Characteristics of Desmoplastic Small Round Cell Tumor (DSRCT) to enhance the diagnostic proficiency of this condition.MethodsA retrospective analysis was performed on clinical data and multimodal imaging manifestations (CT, MRI, FDG-PET/CT) of eight cases of DSRCT. These findings were systematically compared with pathological results to succinctly summarize imaging features and elucidate their associations with both clinical and pathological characteristics.ResultsAll eight cases within this cohort exhibited abdominal-pelvic masses, comprising six solitary masses and two instances of multiple nodules, except for one case located in the left kidney, the remaining cases lacked a clear organ source. On plain images, seven cases exhibited patchy areas of low density within the masses, four cases showed calcification within the masses. Post-contrast imaging displayed mild-to-moderate, uneven enhancement. Larger masses displayed patchy areas without significant enhancement at the center. In the four MRI examinations, T1-weighted images exhibited uneven, low signal intensity, while T2-weighted images demonstrated uneven high signal intensity. Imaging unveiled four cases of liver metastasis, four cases of ascites, seven cases of lymph node metastasis, three cases of diffuse peritoneal thickening, and one case involving left ureter invasion with obstruction. In the FDG-PET/CT examinations of seven cases, multiple abnormal FDG accumulations were observed in the abdominal cavity, retroperitoneum, pelvis, and liver. One postoperative case revealed a new metastatic focus near the colonic hepatic region. The range of maximum standardized uptake values (SUVmax) for all lesions are 6.62–11.15.ConclusionsDSRCT is commonly seen in young men, and the imaging results are mostly multiple lesions with no clear organ source. Other common findings include intratumoral calcification, liver metastasis, ascites, peritoneal metastasis, and retroperitoneal lymph node enlargement. The combined use of CT, MRI and FDG-PET/CT can improve the diagnostic accuracy and treatment evaluation of DSRCT. However, it is imperative to underscore that the definitive diagnosis remains contingent upon pathological examination.

Distinguishing Characteristics of Benign Versus Malignant Intraosseous Schwannomas: A Comparative Study.

Benign and malignant intraosseous schwannomas are rare, and primarily documented in case reports. This study aims to elucidate the differences in clinical features and imaging manifestations between these tumors. This will help clinicians identify malignant lesions at an early stage, reliable guide treatment decisions, and accurately predict outcomes. Eighteen patients who underwent surgery and got pathological examinations in our hospital from 2012 to 2023 were retrospectively reviewed. Among them, 14 cases were found benign with 4 malignant. In the benign group, patients underwent curettage followed by bone grafting, whereas the malignant group was treated with extensive resection or amputation. Patients' demographics and radiographic features, including gender, age at diagnosis, symptom duration, tumor location, tumor margin, and the ratio of sclerotic margins were documented and compared between these tumors. All imaging was reviewed by two fellowship-trained musculoskeletal radiologists, who also quantified the sclerotic margin ratio. The intraclass correlation coefficient was used to determine inter-observer agreement. The Mann-Whitney U test was applied for continuous clinical variables, and the chi-square test or Fisher's exact test for categorical variables. In our series, the mean age of these patients was 43.1 ± 14.0 years, six patients were male and 12 were female. Pain was the predominant preoperative symptom. The average duration from symptom onset to initial physician visit was 28.5 ± 25.3 months for benign schwannomas and 8.3 ± 4.3 months for malignant schwannomas (p = 0.012). On plain radiographs, 13 (13/14) of benign schwannomas exhibited well-defined margins of bone destruction, compared to 1 (1/4) of malignant schwannomas (p = 0.019). Furthermore, benign schwannomas had a significantly higher sclerotic margin ratio (75.5%) than malignant ones (16.7%) (p = 0.001). No statistically significant difference was found between the two groups in terms of cortical bone destruction (p = 1.0). On MRI, both tumors demonstrated intermediate to slightly hypointense signal intensity on T1-weighted images and heterogeneous high signal intensities on T2-weighted images. Despite their rarity, benign and malignant intraosseous schwannomas should be considered in the differential diagnosis for patients presenting with painful and radiographically lytic bone lesions, especially in the mandible, sacrum, and vertebrae. The ratio of sclerotic margins, which we proposed for the first time, in combination with symptom duration and the clarity of tumor margins, provide valuable diagnostic clues for distinguishing the malignancy of the tumors.

Diagnostic yield of a novel tracer 68Ga-citrate in sarcoidosis patients.

Sarcoidosis is a granulomatous disease of unknown origin. Conventional laboratory and imaging modalities may lead to equivocal conclusions for sarcoidosis diagnosis. 68Ga-citrate PET/CT has been utilized in the diagnosis of inflammatory and infectious diseases due to its beter performance. Aims: This study was designed to determine the clinical trenchancy of 68Ga-citrate in sarcoidosis patients as an alternative tracer that binds to the somtastotin receptors of the inflammatory cells in sarcoid granulomas because current laboratory modalities may occasionally lack accuracy for sarcoidosis diagnosis. Conventional criteria including clinical, laboratory, radiologic modalities, and 18F-FDG PET/CT were compared with the 68Ga-citrate PET/CT to evaluate the diagnostic yield in sarcoidosis. Forty-four sarcoidosis patients were include in the study. Conventional laboratory and imaging modalities were done in 44 while 68Ga-citrate PET/CT and 18F-FDG-PET/CT were performed in 22 patients. The three modalities were compared with in regard to granulomatous activity evaluation, extrapulmonary organ involvement, and identification of coexistent malignant disease. 68Ga-citrate PET/CT revealed a significantly higher diagnostic yield for sarcoidosis compared to conventional laboratory and 18F-FDG-PET/CT imaging modalties. 68Ga-citrate PET/CT revealed 72.7% sensitivity and 68.4% specificity for the detection of granulomatous inflammation in sarcoidosis. 68Ga-citrate PET/CT was conclusive for activity assessment in sarcoidosis for diagnosis, activity assessment, and identification of extrapulmonary organ involvement. As an innovative novel tracer, 68Ga-citrate identified disease activity, extrapulmonary organ involvement, biopsy sites, and coexistent malignancy due to its chemical properties with a higher statistical diagnostic yield compared to conventional laboratory findings and the PET/CT imaging manifestations in sarcoidosis.

Clinical features, radiological findings and prognosis of microscopic polyangiitis with interstitial lung disease: a retrospective matched control study

BackgroundThe association between interstitial lung disease (ILD) and microscopic polyangiitis (MPA) has received increasing attention in recent years. However, there are still no studies comparing clinical characteristics and prognoses between MPA-ILD patients and patients with ANCA-negative ILDs. Therefore, the purpose of this study was to analyse a group of patients presenting MPA-ILD matched with patients exhibiting ANCA-negative ILDs to identify differences in their clinical characteristics and survival.MethodsThis study retrospectively reviewed the data of 60 patients with MPA-ILD and 60 patients with ANCA-negative ILDs who were matched for age, sex, and patterns on chest high-resolution CT (HRCT) images. The baseline clinical information, laboratory parameters and chest CT data were collected and analysed at each patient’s initial diagnosis.ResultsSixty of the 682 (8.8%) ILD patients were diagnosed with MPA-ILD. MPA-ILD patients tended to be older and have higher CRP and ESR levels. ILD antedated MPA in 61.7% (37/60) of the patients, and MPA occurred on average (45.1 ± 33.4) months after the ILD diagnosis. Compared with matched ANCA-negative ILD patients, MPA-ILD patients had higher CRP and serum creatinine levels and lower haemoglobin levels. UIP (63.3%) was the most common chest HRCT pattern, and the proportion of patients with oddly shaped cysts (P = 0.04) was significantly greater in the MPA-ILD group than in the matched ANCA-negative ILD group. The number of MPA-ILD patients was significantly shorter than that of ANCA-negative ILD patients (P = 0.005). Survival analysis revealed that acute exacerbation (AE) of ILD (HR 2.40, 95% CI 1.03–5.59, P = 0.043) and diffuse alveolar haemorrhage (HR 3.42, 95% CI 1.09–10.73, P = 0.036) were independently associated with shorter survival and that receiving glucocorticoids combined with immunosuppressants (HR 0.11, 95% CI 0.03–0.37, P < 0.001) was independently associated with prolonged survival in MPA-ILD patients.ConclusionsThe proportion of MPA-ILD patients with total ILD is not low, and ANCA testing of ILD patients is necessary. Oddly shaped cysts with a UIP pattern may be a characteristic chest imaging manifestation of MPA-ILD. The prognosis of MPA-ILD is poor, especially for patients who are older, have DAH, and have experienced AEs.

Comparative Evaluation of CEUS and CECT in the Detection of Liver Metastases of Middle and Low Rectal Cancer.

To explore the imaging manifestations and clinical application value of contrast-enhanced ultrasound (CEUS) in liver metastases of middle and low rectal cancer by performing CEUS in patients. Additionally, we compared the results of CEUS with those of abdominal contrast-enhanced computed tomography (CECT) to assess the reliability of diagnosing liver metastases in patients with middle and low rectal cancer. Hepatic CEUS was performed in 1095 patients with middle and low rectal cancer, and all patients underwent abdominal CECT examinations to determine the presence or absence of liver metastases. The results of both examinations were compared to evaluate the value of hepatic CEUS for detecting liver metastases in patients with middle and low rectal cancer. Among 1095 patients with middle and low rectal cancer, 132 were diagnosed with liver metastases of middle and low rectal cancer. 130 cases of liver metastases of rectal cancer were identified using hepatic CEUS, whereas 126 cases were identified using abdominal CECT. The detection rates of hepatic CEUS and abdominal CECT for liver metastases of middle and low rectal cancer showed no statistically significant differences (P > 0.05). The Kappa value for the diagnosis of liver metastases of middle and low rectal cancer between hepatic CEUS and abdominal CECT was 0.974 (P < 0.001), indicating good consistency between the two imaging modalities in detecting liver metastases of middle and low rectal cancer. Hepatic CEUS can be used to diagnose liver metastases in middle and low rectal cancer, providing crucial imaging evidence for clinical treatment planning. It exhibited higher sensitivity than that of abdominal CECT in diagnosing liver metastases of middle and low rectal cancer, enabling the identification of higher number of liver metastases of middle and low rectal cancer cases.

Multimodal imaging of mixed epithelial and stromal tumor of the kidney: Case series.

To investigate the clinical features, imaging manifestations, and pathological characteristics of mixed epithelial stromal tumor of the kidney (MESTK) to improve the understanding of MESTK and the accuracy of preoperative imaging diagnosis. The clinical, imaging, and pathological data of 3 patients with MESTK confirmed by postoperative pathology were retrospectively analyzed. Three patients with MESTK were middle-aged women with no obvious clinical symptoms. The main image representation showed a multilocular cystic or solid-cystic mass, with the larger masses protruding from the kidney contour, with multiple separations, which could be of unequal thickness. The cystic component showed no enhancement on enhancement scans, whereas the segregations and solid components showed gradual and obvious enhancement. Microscopic pathology was characterized by the biphasic differentiation of mesenchymal and epithelial components. MESTK is a rare, mostly benign tumor that appears as a multilocular cystic or cystic solid, with progressive marked enhancement of the septal and solid components on enhanced scans. This imaging feature is helpful for the diagnosis of MESTK.

Evaluating the diagnostic performance of [18F]ALF-NOTA-FAPI-04 PET/CT in gastric cancer: a comparative study with [18F]FDG PET/CT.

To compare the diagnostic value of [18F]ALF-NOTA-FAPI-04 positron emission tomography/computed tomography (PET/CT) and 18F-fluorodeoxyglucose (FDG) PET/CT in gastric cancer. This single-center retrospective analysis included 65 patients with gastric cancer who received both [18F]FDG and [18F]ALF-NOTA-FAPI-04 PET/CT for initial staging or restaging. Histopathological manifestations, typical imaging manifestations, follow-up imaging, and comprehensive clinical assessment were used as reference criteria. The uptakes of [18F]FDG and [18F]ALF-NOTA-FAPI-04 PET were compared using the Wilcoxon signed-rank test. McNemar's test was employed to compare the diagnostic performance of the two imaging techniques. A total of 65 patients were included (26 male and 39 female; mean age, 54.03 ± 10.41 years), Among them, 10 were newly diagnosed, 46 underwent radical gastrectomy, and 9 received only chemotherapy prior to the study. Compared with [18F]FDG PET/CT, [18F]ALF-NOTA-FAPI-04 PET/CT showed higher sensitivity in primary or recurrent tumors (100% vs. 64.52%, p < 0.001)), lymph node metastases (88.89% vs. 38.89%, p = 0.006), distant metastases (91.18% vs. 50%, p < 0.001). From the semi-quantitative evaluation, the Maximum standardized uptake value (SUVmax) and target-to-background ratio of [18F]ALF-NOTA-FAPI-04 PET/CT were significantly higher than that of [18F]FDG PET/CT in primary or recurrent tumors, lymph node metastases, and distant metastases (all p < 0.001). Our study results indicate that [18F]ALF-NOTA-FAPI-04 PET/CT outperforms [18F]FDG PET/CT in the detection of primary or recurrent tumors, lymph node metastasis, and distant metastasis in gastric cancer. Question Early diagnosis and precise staging of gastric cancer are crucial for patient prognosis; however, current imaging techniques still face significant limitations. Findings [18F]ALF-NOTA-FAPI-04 PET/CT demonstrated significantly higher sensitivity than [18F]FDG PET/CT in detecting primary or recurrent tumors and metastases in patients with gastric cancer. Clinical relevance [18F]ALF-NOTA-FAPI-04 PET/CT is an advanced imaging diagnostic technique that significantly enhances the diagnostic accuracy for gastric cancer and its metastatic lesions. This technology provides robust support for clinical decision-making, thereby improving the management of patients with gastric cancer.

Clinical and chest CT manifestations of Talaromycosis marneffei: a retrospective study comparing anti-IFN-γ autoantibodies-positive and HIV-positive cases

BackgroundTo explore the clinical and chest CT features of Talaromycosis marneffei (TSM), and to compare the differences between anti‑IFN‑γ autoantibodies‑positive and HIV-positive cases.MethodsClinical data and chest CT images of 54 HIV-negative patients with Talaromyces marneffei (TM) infection and positive anti-interferon-γ (anti-IFN-γ) autoantibody were retrospectively analyzed. Ninety-three HIV-positive patients with TM infection during the same period were included as controls. Differences between groups were compared by the two-sample t-test and the Mann-Whitney U test, respectively.ResultsThe time from symptom onset to diagnosis of TSM with positive anti-IFN-γ autoantibodies was significantly longer than that of controls (P < 0.001). BALF/sputum and lymph nodes were the better specimens for detecting TM in the anti-IFN-γ autoantibody-positive group, while TM were more often isolated or detected in blood samples in the other group. Patients with TM infection tended to present with cough, expectoration, and fever. Compared with controls, anti-IFN-γ antibody-positive patients with TM infection had a higher incidence of shortness of breath, skin lesions, joint pain, and high CD4/CD8 ratio (P < 0.05). There were only 1 and 6 cases with negative lung involvements in CT scans in anti-IFN-γ autoantibody-positive patients and HIV-positive patients with TM infection, respectively. In the remaining patients, chest CT manifestations were diverse, mainly presenting as fibrous cord‑like lesions, lymph node enlargement, and sporadic nodules. The incidences of patchy consolidation, air bronchogram, pleural effusion and pleural thickening were higher in anti-IFN-γ autoantibody-positive patients with TM infection than those of controls (P < 0.05).ConclusionsAnti-IFN-γ antibody positive patients with TM infection showed a longer diagnostic interval. clinical specimens from which TM was isolated or detected were different between the two groups. The clinical and imaging manifestations of patients with TM infection are characteristic.

Hepatobiliary phase image manifestation classification and pathological features of nodules in nodules accompanied by hepatocellular carcinoma

Objective: To analyze the hepatobiliary phase (HBP) image manifestation classification and pathological features of nodules in nodules accompanied by hepatocellular carcinoma (NIN-HCC). Methods: Twenty-five cases cases (27 lesions) with cirrhosis who were confirmed as NIN-HCC by surgical pathology and underwent gadoxetate disodium-enhanced MRI examination before surgery at Nantong Third Hospital affiliated with Nantong University from July 2015 to November 2022 were retrospectively enrolled. The size, signal intensity, enhancement pattern, and pathological features of internal and external nodules were analyzed in NIN-HCC. The lesions score were recorded according to the 2018 version of the Liver Imaging Reporting and Data Systems (LI-RADS) classification criteria. NIN-HCCs were grouped and typed according to the different HBP signal intensities of the inner and outer nodules. The independent-samples t-test, Mann-Whitney U test or Fisher's exact probability method were used to compare the differences in imaging features and LI-RADS scores between the groups. The Spearman correlation coefficient was used to evaluate the correlation between the pathological differentiation degree of internal and external nodules and the HBP signal intensity. The Kaplan-Meier curve was used to analyze recurrence-free survival (RFS) following NIN-HCC surgery. Results: The internal nodules of the 27 NIN-HCCs showed altered hypervascularity with a maximum diameter of (13.2±5.5) mm during the arterial phase. 51.9% (14/27) and 48.1% (13/27) showed "fast in and fast out" and fast in and slow out"enhancement patterns. The external nodules showed altered hypovascularity with a maximum diameter of (25.7±7.3) mm, and 13 (48.1%) of them were accompanied to manifest during the arterial phase. NIN-HCC was divided into two groups according to the signal intensity of HBP of the outer nodules with the background liver parenchyma signal intensity as a reference: the hyposignal group (n=17, 63.0%) and the isosignal group (n=10, 37.0%). The hyposignal group and the isosignal group were divided into A~C type and D~F type, a total of six types, according to the hypo, iso, and hyper signals of the inner nodules and the signal intensity of the outer nodules as a reference. Within the hyposignal group, 7.4% (2/27) of the inner nodules showed hyposignal (type A), 37.0% (10/27) showed isosignal (type B), and 18.5% (5/27) showed hypersignal (type C). Within the isosignal group, 29.6% (8/27) of the inner nodules showed hyposignal (type D), 7.4% (2/27) showed isosignal (type E), and there was no hypersignal (type F). 40.7% (11/27) of the lesions were LR-4 in LI-RADS score, and 59.3% (16/27) were LR-5. There was no statistically significant difference (P>0.05) in the maximum diameter, enhancement pattern, and LI-RADS score of internal and external nodules between the hypo and iso signal group. Histologically, NIN-HCC showed fine trabecular/pseudoglandular duct type without microvascular invasion, among which the inner nodules were mainly moderately differentiated HCC, and the outer nodules were mainly well-differentiated HCC. The degree of differentiation between the inner and outer nodules and the HBP signal intensity had no statistically significant difference (r=0.290, P=0.143; r=0.079, P=0.697). The median RFS follow-up time after NIN-HCC radical resection was 31.7 months, and the cumulative RFS rates at 1, 3, and 5 years were 96.0%, 76.0%, and 64.0%, respectively. Conclusions: NIN-HCC can serve as a morphological marker for early-stage diagnosis of multi-step cancer evolution in HCC, with certain imaging and pathological features. HBP imaging classification is helpful to enhance the diagnostic recognition of this disease.

Urothelial carcinoma of the renal pelvis with squamous and sarcomatoid differentiation complicated by hydronephrosis and pyelonephritis: a case report and literature review

BackgroundRenal pelvic urothelial carcinoma with multiple histological variants co-occurs with hydronephrosis and pyelonephritis extremely rarely. The diagnosis of renal pelvic urothelial carcinoma can be complicated by these conditions, leading to delayed or missed diagnosis or misdiagnosis.Case presentationWe report the evolutionary course of a rare case of renal pelvic urothelial carcinoma containing squamous and sarcomatoid differentiation associated with hydronephrosis and pyelonephritis in a low-functioning kidney. Preoperative clinical and imaging manifestations were highly suggestive of hydronephrosis and pyelonephritis; however, all corresponding therapeutic measures failed. Eventually, nephrectomy was performed, and postoperative pathological examination revealed renal pelvic urothelial carcinoma with squamous and sarcomatoid differentiation. Further residual ureter and bladder cuff resection was refused by the patient. Regular cisplatin-based postoperative chemotherapy and bladder perfusion were arranged, and cystoscopy and imaging examinations were performed regularly for follow-up.ConclusionHydronephrosis and pyelonephritis can mask the typical clinical and imaging manifestations of renal pelvic urothelial carcinoma. Renal pelvic malignancy should be considered in patients with intractable pyelonephritis and hydronephrosis. There is no standard treatment for renal pelvic carcinoma with multiple pathological types. Radical surgery is considered an appropriate option and should be performed as early as possible. Chemotherapy and immunotherapy may improve patient survival.

Impulse oscillometry system and pulmonary function test assessment of the impact of tumor location, staging, and pathological type on lung function in primary lung cancer

PurposeTo study the effects of tumor site, stage, pathologic type and imaging findings on lung function in primary lung cancer, as well as the correlation between impulse oscillometry system (IOS) and pulmonary function test (PFT) parameters.MethodsThe impact of tumor location, staging, and pathological type on lung function were evaluated in 219 patients with primary lung cancer through IOS and PFT. Spearman correlation coefficient was used to analyze the relationship between IOS parameters and PFT parameters.ResultsThe PFT parameters in adenocarcinoma were significantly higher than those in SCLC, while the other parameters in IOS were obviously lower than those in SCLC except X5Hz (P < 0.05). The PFT parameters of FVC%, FEV1% and MVV% in SCC were evidently higher than those in SCLC, while the parameters of IOS were significantly lower than those in SCLC (P < 0.05). The PFT parameters of adenocarcinoma were higher than those of SCC (P < 0.05). In the PFT parameters of stage I patients, FEV1/FVC%, MEF50%, MMEF75/25%, and DLCO% were markedly higher than those of stage II patients, and FVC%, FEV1%, FEV1/FVC%, MEF50%, MEF25%, PEF%, MMEF75/25%, TLC%, and DLCO% were obviously higher than those of stage III and IV patients; and the MVV%, Z5Hz%, R5Hz% in IOS parameters were obviously lower than those in stage III, while Fres (1/s) and X5Hz were significantly lower than those in stage IV (P < 0.05). Compared with Phase IV, the X5Hz of stage II patients was clearly higher (P = 0.023). Besides, PFT parameters of peripheral lung cancer were obviously higher than those of central lung cancer (P < 0.05), while Z5Hz%, Fres (1/s) and R5Hz% of IOS parameters were clearly lower than those of central lung cancer (P < 0.05). Moreover, for patients without and with other pulmonary imaging manifestations, the PFT parameters of the former were significantly higher than those of the latter (P < 0.05), while only Fres (1/s) of IOS parameters was significantly lower than the latter (P < 0.05). Furthermore, there is a low to moderate correlation between IOS parameters and PFT parameters.ConclusionPatients with central SCLC and SCC and advanced lung cancer had the worst lung function. The IOS parameters show a good correlation with the traditional PFT parameters, and IOS can be used as an alternative measurement method for PFT when necessary.